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Protocol Compliance (protocol + compliance)
Selected AbstractsA protocol is not enough to implement an enhanced recovery programme for colorectal resection,BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 2 2007J. Maessen Background: Single-centre studies have suggested that enhanced recovery can be achieved with multimodal perioperative care protocols. This international observational study evaluated the implementation of an enhanced recovery programme in five European centres and examined the determinants affecting recovery and length of hospital stay. Methods: Four hundred and twenty-five consecutive patients undergoing elective open colorectal resection above the peritoneal reflection between January 2001 and January 2004 were enrolled in a protocol that defined multiple perioperative care elements. One centre had been developing multimodal perioperative care for 10 years, whereas the other four had previously undertaken traditional care. Results: The case mix was similar between centres. Protocol compliance before and during the surgical procedure was high, but it was low in the immediate postoperative phase. Patients fulfilled predetermined recovery criteria a median of 3 days after operation but were actually discharged a median of 5 days after surgery. Delay in discharge and the development of major complications prolonged length of stay. Previous experience with fast-track surgery was associated with a shorter hospital stay. Conclusion: Functional recovery in 3 days after colorectal resection could be achieved in daily practice. A protocol is not enough to enable discharge of patients on the day of functional recovery; more experience and better organization of care may be required. Copyright © 2006 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Preoperative conditioning with oral carbohydrate loading and oral nutritional supplements can be combined with mechanical bowel preparation prior to elective colorectal resectionCOLORECTAL DISEASE, Issue 9 2008P. O. Hendry Abstract Objective, Preoperative conditioning with oral fluid and carbohydrate (CHO) loading allows the patient to undergo surgery in the fed state and is associated with reduced postoperative insulin resistance. Further benefit may accrue from oral nutritional supplements (ONS) to counteract the fasting associated with mechanical bowel preparation (MBP). In this study we assess the ability to prescribe, dispense and have patients comply with a protocol combining preoperative ONS and CHO/fluid loading during MBP. Method, One hundred and forty-seven patients undergoing elective left colonic or rectal resection were recruited to an Enhanced Recovery after Surgery (ERAS) programme. All patients were prescribed MBP (2 sachets Picolax). On the daytime prior to surgery, eligible patients were prescribed 2 × 200 ml of ONS (Fortijuice®, Nutricia) and in the evening 800 ml oral CHO/fluid loading (Preop®, Nutricia,). Patients were prescribed a further 400 ml of oral/CHO/fluid on the morning of surgery 2 h prior to induction of anaesthesia. Protocol compliance was audited prospectively. Results, One hundred and forty-seven patients received MBP. Twenty-three patients were ineligible for oral CHO/fluid loading [diabetes (n = 22), allergy to lemon flavoured drinks (n = 1)]. Fourteen patients did not receive the preoperative CHO drinks due to failure to prescribe (n = 8) or dispense (n = 6). One hundred and ten patients were dispensed the combined ONS and CHO/fluid loading regimen, compliance rates were 83% with ONS, 80% with CHO/fluid loading and 74% with both. Conclusion, Approximately 74% of patients undergoing MBP can comply with preoperative conditioning with ONS and CHO/fluid loading. Prescription and dispensing requires close attention to detail. [source] Putting flesh and polish on autoimmune hepatitis and moving the disease of exclusion to inclusion,HEPATOLOGY, Issue 4 2010Albert J. Czaja Autoimmune hepatitis emerged during an era when concepts of neonatal immune tolerance, clonal selection of lymphocytes, and "forbidden clones" of activated immune cells were forming. The diagnosis had to be deduced from circumstantial evidence and by exclusion of other conditions. The goals of this review are to demonstrate how a clinician nonscientist can contribute to the maturation of autoimmune hepatitis and to illustrate the principles of clinical investigation that can be applied broadly to other projects. Autoimmune hepatitis initially had to be distinguished from other diseases, and improvements in the tests for viral and immune markers were instrumental in this regard. Diversification of the clinical phenotype to accommodate acute severe, asymptomatic, elderly, and variant forms enhanced the pertinence of the disease, and the formation of the International Autoimmune Hepatitis Group standardized the diagnosis, interconnected investigators, and promoted global acceptance of the condition. Subsequent studies refined current corticosteroid-based therapies, identified prognostic markers, assessed genetic predispositions, explored new pharmacological agents, and forecast the emergence of cellular and molecular interventions. Good fortune, stimulating mentors, career dedication, practical goal selection, protocol compliance, compulsive record keeping, personal resilience, and strong collaborations were the bases for progress. Autoimmune hepatitis exemplifies an evolutionary process in the science of autoimmunity and the people committed to its study. Lessons derived from this experience can be far-reaching. (HEPATOLOGY 2010;52:1177-1184) [source] A quality assurance audit: Phase III trial of maximal androgen deprivation in prostate cancer (TROG 96.01)JOURNAL OF MEDICAL IMAGING AND RADIATION ONCOLOGY, Issue 1 2000A Steigler SUMMARY In 1997 the Trans-Tasman Radiation Oncology Group (TROG) performed a quality assurance (QA) audit of its phase III randomized clinical trial investigating the effectiveness of different durations of maximal androgen deprivation prior to and during definitive radiation therapy for locally advanced carcinoma of the prostate (TROG 96.01). The audit reviewed a total of 60 cases from 15 centres across Australia and New Zealand. In addition to verification of technical adherence to the protocol, the audit also incorporated a survey of centre planning techniques and a QA time/cost analysis. The present report builds on TROG's first technical audit conducted in 1996 for the phase III accelerated head and neck trial (TROG 91.01) and highlights the significant progress TROG has made in the interim period. The audit provides a strong validation of the results of the 96.01 trial, as well as valuable budgeting and treatment planning information for future trials. Overall improvements were detected in data quality and quantity, and in protocol compliance, with a reduction in the rate of unacceptable protocol violations from 10 to 4%. Audit design, staff education and increased data management resources were identified as the main contributing factors to these improvements. In addition, a budget estimate of $100 per patient has been proposed for conducting similar technical audits. The next major QA project to be undertaken by TROG during the period 1998,1999 is an intercentre dosimetry study. Trial funding and staff education have been targeted as the key major issues essential to the continued success and expansion of TROG's QA programme. [source] Salivary cortisol and psychosocial hazards at workAMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 3 2009Giovanni Maina MD Abstract Background Experimental and clinical evidence suggest that stress can lead to ill-health through the disregulation of the hypothalamic,pituitary,adrenal (HPA) axis. Studies to date have produced equivocal results likely due to different methodologies and failure to account for confounding factors. This investigation aimed to assess the relation between self-reported work-related stressors and salivary cortisol and to clarify the role of the potential confounders. Methods Thirty-six call-handlers completed a self-administered job content questionnaire and collected seven daily salivary samples on two workdays and a weekend. The diurnal salivary cortisol output was expressed as cortisol awakening response (CAR), and cortisol output in the rest of the day. Salivary cortisol data were normalized by means of square root transformation. The generalized estimating equations method was used to assess the relation between job strain and cortisol levels after adjusting for gender, weekdays and adherence to the sampling schedule. Results Job strain significantly influenced the total amount of cortisol response to waking (high strain vs. low strain: 1.1 (0.3,2.0) nmol/L). The cortisol response to waking showed gender-specific differences [women excreting greater cortisol than men: 1.1 (0.3,1.9) nmol/L], and weekday differences [workdays vs. weekend: 1.0 (0.3,1.6) nmol/L]. Non-compliance with the sampling protocol was associated with lower salivary cortisol than in adherent subjects. Conclusions Our results provide further evidence for the HPA axis involvement in the physiological response to work stress. The measure of the CAR showed to be the sensitive index to assess the physiological response to psychosocial factors. Gender, weekday, and protocol compliance were confounding factors. Am. J. Ind. Med. 52:251,260, 2009. © 2008 Wiley-Liss, Inc. [source] Web communication services and the PacketIN® application hosting environmentBELL LABS TECHNICAL JOURNAL, Issue 1 2002Yang Chen Large telecommunication customers are migrating their network infrastructure to support new converged services, while containing their operating costs. Deploying converged services on the networks today represents great opportunities to network service providers for new revenue generation. It brings big challenges as well, due to the requirements for a service platform with high capability to deal with the complexity of the network infrastructure, the difficulty of interoperability between different service platforms, and the diversity of signaling protocols and application programming interfaces (APIs). The Lucent PacketIN® application hosting environment (AHE) provides a solution that empowers network service providers to deliver a wide variety of enhanced services over the converged (packet and circuit, wireline and wireless) networks. It enables the creation and deployment of enhanced services on converged networks via the open service platform with interoperability, programmability, scalability, and wide protocol compliance. In particular, a new class of services is presented to demonstrate the transformation of telecommunication services that is enabled through Web presence. This article gives an overview of the PacketIN AHE with the focus on the customer values, the architecture, and enabling capability to deploy advanced applications and services. A new service portal, enterprise communication, is presented as an example of the innovation and implementation enabled by the service enabling environment. The enterprise communication provides Web access to presence information, instant messaging, third-party call management, and location. This convergence of features is enabled by the PacketIN AHE integration of the public switched telephone network (PSTN), session initiation protocol (SIP), and H.323 protocols through standard open APIs. The voice communication protocols are combined with a Web access interface to establish a new Internet presence, while leveraging existing switching products and reusing deployed communication networks and services. © 2002 Lucent Technologies Inc. [source] | ||||||||||